目的探讨炭黑尘肺合并结核的鉴别诊断。方法对职业史、既往史、劳动卫生学和职业健康监护等资料进行综合分析,采用动态胸片观察、CT辅助检查等手段,排除其他疾病可能后诊断为尘肺病。结果患者X线胸片显示:两中上肺可见粟粒状、条索状阴影,大小不均,密度不均,右侧肋膈角消失,有明显的胸膜病变征象。CT影像可见右中肺有一处明显的结核灶,其周围还有一些高密度的卫星灶,右下肺存在胸膜病变,两中上肺可见弥漫性圆形小阴影,大小均匀,分布均匀,为典型的尘肺病CT影像改变。诊断为炭黑尘肺壹期。结论炭黑尘肺X线胸片上有可能表现为q影。CT检查对尘肺病的鉴别诊断较有价值。 Objective To investigate the differential diagnosis of pneumoconiosis complicated with tuberculosis. Methods The occupational history, past history, labor hygiene and occupational health monitoring data were analyzed comprehensively. Dynamic chest radiography and CT aided examination were used to exclude the possibility of other diseases being diagnosed as pneumoconiosis. Results The X-ray showed that there were obvious signs of pleural disease in both lungs, including miliary and cord-like shadows, uneven size, uneven density and disappearance of the right medial costophrenic angle. CT image shows the right lung has a clear tuberculosis focus, there are some high-density satellite lesions around it, there is pleural disease in the lower right lung, two in the upper lung can be seen diffuse small round shadows, uniform size, uniform distribution of Typical pneumoconiosis CT images change. Diagnosis of carbon black pneumoconiosis one. Conclusion Carbon pneumoconiosis X-ray may appear on the q-ray. CT examination of the differential diagnosis of pneumoconiosis more valuable.